1336213925 NPI number — VISHAL GOEL PSC

Table of content: (NPI 1336213925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336213925 NPI number — VISHAL GOEL PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISHAL GOEL PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336213925
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1477
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40476-1477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-626-4797
Provider Business Mailing Address Fax Number:
859-626-0519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
789 EASTERN BYP
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-626-4797
Provider Business Practice Location Address Fax Number:
859-626-0519
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOEL
Authorized Official First Name:
VISHAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-626-4797

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  KY34522 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RP1001X , with the licence number: KY34522 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RS0012X , with the licence number: KY34522 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007304196 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1188578 . This is a "CHA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64028095 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000328758 . This is a "ANTHEM BLUE CROSS & BLUE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: H32765 . This is a "BLUE GRASS FAMILY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 65941213 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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